BPPV( Benign Paroxysmal Positional Vertigo) Concept

Introduction
It is an peripheral vestibular disorder. Benign – means that is not life threatening and will generally not progress. Paroxysmal – symptoms occur suddenly in brief episodes of mild to intense vertigo.
Positional – describe how changes in head position cause symptoms. Positional change may be looking up and down, lying down or rolling over in bed or sitting up quickly.
Vertigo – used to describe sensation of movement or spinning occur following a position change. Vertigo is last for about 1-2minutes and will go away even if the precipitating position is maintained. The unsteadiness of BPPV can lead to falls, which are a leading cause of fractures.However, the symptoms of BPPV can be very frightening and may be dangerous, especially in adults over the age of 65.
CAUSES: Age of 50 and in most cases, a result of an age-related degeneration of the vestibular system. Other causes Mild to severe head injury ,Whiplash injury,Surgery causing trauma to the ear,Prolonged inactivity
and Migraine.
calcium carbonate crystals, also known as otoconia, becoming displaced in the inner ear.Keeping the head in the same position for a long time, such as in the dentist chair, at the beauty salon or during strict bed rest.
Bike riding on rough trails.
High intensity aerobics.
Other inner ear disease (ischemic, inflammatory, infectious)
MECHANISM: Canalithiasis :
Otoconia are free floating in semicircularcanal.Reorientation of the canals causes otoconia to move to the lowest part of
canals ,creating a drag on the endolymph , resulting in fluid pressure on the cupula and activating ampullary organ.
Cupulolithiasis:
Dislodged otoconia directly attach to cupula , weighting this membrane .Reorientation of canal relative to gravity deflects cupula , exciting or inhibiting the ampullary organ. When the head moves, this displaced otoconia in the semicircular canals sends a false signal to the brain, causing vertigo.
clinical features:Vertigo is last for about 1-2minutes,
Nystagmus ,Light headedness
,Disequilibrium and sometimes nausea ,vomiting , pallor and sweating.
EVALUATION:Dix-Hallpike Maneuver: The Dix-Hallpike along with patient's history → diagnostic of BPPV,Roll test.
POSTUROGRAPHY
ELECTRONYSTAGMOGRAPHY (ENG): for detecting preexisting vestibular pathology
VIDEO NYSTAGMOGRAPHY (VNG) -Video images of the eyes are obtained without direct contact using high resolution cameras with infrared illumination.
MANAGEMENT:MEDICAL MANAGEMENT:
Symptomatic management is administered
Longer acting vestibular suppressants like clonazepam for chronic disequilibrium
Vertin – vertigo,Betehistine - Nausea and vomiting
“Does not treat underlying cause”
PHYSIOTHERAPY MANAGEMENT
VESTIBULAR REHABILITATION
Epleys maneuver - anterior and posterior canal BPPV
Low dose diazepam - used prior to CRP
Other maneuvers
-Liberatory maneuver- Posterior canal BPPV
-Brand -Daroff maneuver
-Bar- B - Que roll maneuver - Horizontal canal BPPV
-CAWTHORNE- COOKSEY
SURGICAL MANAGEMENT..

1. BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) Presented by , SAROJINI.J MPT (NEUROLOGY)

2. INTRODUCTION It is an peripheral vestibular disorder. Benign – means that is not life threatening and will generally not progress. Paroxysmal – symptoms occur suddenly in brief episodes of mild to intense vertigo. Positional – describe how changes in head position cause symptoms. Positional change may be looking up and down, lying down or rolling over in bed or sitting up quickly.

3. Vertigo – used to describe sensation of movement or spinning occur following a position change. Vertigo is last for about 1-2minutes and will go away even if the precipitating position is maintained. Other important clinical manifestations of BPPV are

4. CAUSES Age of 50 and in most cases, a result of an age-related degeneration of the vestibular system. Other causes Mild to severe head injury Whiplash injury Surgery causing trauma to the ear Prolonged inactivity Migraine

5. MECHANISM

6. Canalithiasis : Otoconia are free floating in semicircular canal . Reorientation of the canals causes otoconia to move to the lowest part of canals ,creating a drag on the endolymph , resulting in fluid pressure on the cupula and activating ampullary organ. Cupulolithiasis : Dislodged otoconia directly attach to cupula , weighting this membrane . Reorientation of canal relative to gravity deflects cupula , exciting or inhibiting the ampullary organ. When the head moves, this displaced otoconia in the semicircular canals sends a false signal to the brain, causing vertigo

7. clinical features Vertigo is last for about 1-2minutes Nystagmus Light headedness Disequilibrium and sometimes nausea ,vomiting , pallor and sweating.

8. EVALUATION Dix-Hallpike Maneuver: The Dix-Hallpike along with patient's history → diagnostic of BPPV

9. POSTUROGRAPHY

10. ELECTRONYSTAGMOGRAPHY (ENG): for detecting preexisting vestibular pathology VIDEO NYSTAGMOGRAPHY (VNG) -Video images of the eyes are obtained without direct contact using high resolution cameras with infrared illumination.

11. MANAGEMENT MEDICAL MANAGEMENT: Symptomatic management is administered Longer acting vestibular suppressants like clonazepam for chronic disequilibrium Vertin – vertigo Betehistine - Nausea and vomiting “Does not treat underlying cause”

12. PHYSIOTHERAPY MANAGEMENT VESTIBULAR REHABILITATION Epleys maneuver - anterior and posterior canal BPPV Low dose diazepam - used prior to CRP

13. Other maneuvers Liberatory maneuver- Posterior canal BPPV

14. Brand - Daroff maneuver

15. Bar- B - Que roll maneuver - Horizontal canal BPPV

16. CAWTHORNE- COOKSEY EXERCISE

17. SURGICAL MANAGEMENT Surgery is usually reserved for those in whom Canalith repositioning (CRP) fails. Labyrinthectomy Singular neurectomy Vestibular nerve section

18. THANK YOU……….